Question about bone age

[lilgymmie7]

Let me begin by saying that I am not looking for medical advice whatsoever. I just want to see how common this is. Further, my DS is being seen by a doctor already.

My DS had a bone age xray done this week. His pysychiatrist is very concerned that he isn't growing nor gaining weight. He has fallen off of his growth chart and hasn't grown at all really within the last 2 years. He was born at only the 5% for height and weight and now has dropped to the 3%. He was already tiny, but it seems that he may stay tiny.

My question is that his xray showed that his bone age is 11 yrs. and he will turn 13 in June this year. They said that he will still grow, but.... We are still pushing that he sees an endocronoligist because under the direction of his psychiatrist she wants to make sure that the med. she is prescribing to my son is not negatively impacting his weight/height gains. The problem lies in that he has been switched from meds about 3 times and this one seems to have really worked positively on his impulsivity.

Has anyone elses child ever had a bone age xray done and it has come back where the child is younger than their chronological age?


Thank you all!

 

[sleeping judy]

Hi, I have never posted, but wanted to respond to you.

My oldest had an xray earlier this year to determine his bone age for the same reason. He already goes to an endo for another issue and they wanted to make sure he didn't have a growth issue as well. He was a large baby/toddler, but has dropped in the growth chart the older he gets.

He was nine at the time of the xray and his bone age came back as that of a six or a seven year old. The endo said that was good as it means he has a while before he enters puberty and will be a "late bloomer." They said they would be more concerned if his bone age had been older than or at his chronological age.

Dh and I are not very large people. I am 5'5" and dh is 5'10" All of our children have started out large and off the charts because they are so tall. I am now noticing our seven year old dd following in the same growth pattern as oldest child.

 

[clrmom]

My stepson had the same issue when he was in middle school. I think we actually had the tests when he was in 8th grade and his bone age was younger than his regular age. He ended up having 2 growth hormone shots and now at 19 he is about 5' 9 1/2". My husband really believes he would have grown to that height even without the shots (it is how tall my husband is as well), but at the time he and his ex-wife decided to go ahead and do the shots as the doctor suggested at the time. My stepson is adhd and on medicine also and I know that was part of the concern at the time. However, my husband was pretty small going into high school also (w/out medicine, just naturally) and so he feels that it was more hereditary than medicine involved.

 

[bpatient]

Let me begin by saying that I am not looking for medical advice whatsoever. I just want to see how common this is.

It's not uncommon. Among elite female gymnasts, it may almost be the norm: female gymnasts who competed in the 2002 European championships were, on average, 2 1/4 years younger in skeletal age than in chronological age. [ J Clin Endocrinol Metab, September 2004, 89(9):4377– 4382] Since your child is male--and you didn't indicate if he was a gymnast--training-related factors and selection bias (e.g., choosing small kids for advanced training) may not apply, but there are clearly many children who have a skeletal age that lags years behind their chronological age.

My daughter is among them; her skeletal age is two years behind her chronological age. She just entered her growth spurt, years behind her peers, and a year after her pediatrician suggested that we might want to consider growth hormone because she was falling off the growth chart. My child will grow to be a small adult--but she's healthy and happy, and that's just the way it is. Some parents have a difficult time accepting that their son will be shorter than average, because they perceive that short stature has more negative connotations for males than for females, but that issue may be only peripherally related to the primary question of physical health.

FWIW, my wife is an endocrinologist, although she doesn't do pediatric endocrine; she just laughed at the suggestion that dd might need growth hormone injections, but perhaps that's because she has been able to build a successful career and have a fulfilling life despite her modest stature

 

[lilgymmie7]

Thank you to all who responded. DS's Dr. is writing a referral to see an endocronologist. I guess that I worry too much when it comes to my children's health. My DH and I are both shorter in stature, but DS is staying small compared to his cousins and siblings. He also seems to always look so thin. There are times he eats and eats well, but at other times we just can't get him to eat a thing. When he is home he does better, but he rarely eats lunch at school.
Our concerns along with his DR. is that he doesn't eat well, and we are uncertain if it is due to heredity, medicine(ADD, anxiety), or something more internal. DS is a very serious wrestler. He has made comments about wanting to remain small. He thinks it will make him a better wrestler. I have a nagging feeling in my gut that this child almost will do anything to stay small. Therefore we are doing all we can to get to the bottom of it. His psychiatrist thinks that perhaps the stimulant he is on for ADD may be causing the growth and weight delay in some part. But he has been on two other meds and this one has really helped him focus and reduced a lot of his impulsivity. So just taking him off of it completely is not the answer without further information. I want to regulate his 'physical' concerns prior to his entry into high school. I worry that as he ages his desire to be small will not be the same as he encounters other teen's thoughts about how small he is. In kindergarten, he came home crying within the first week because another child told him that he doesn't belong in the class because he looks like a baby and that he has 'baby' hands. Children can be so cruel. My DS already has to deal with anxiety and has been working on gaining appropriate coping skills.

I do feel better that it isn't too uncommon that children have a younger bone age however.

 

[Granny Smith]

The results you want to get from a bone age scan are actually what you got - where the bone age is younger than the chronological age. That means he still can grow.

I believe the reason for the recent drop on the charts is because the standard charts have kids go through a growth spurt before they hit puberty and because your ds is behind he hasn't hit that puberty therefore has not gone through that growth spurt and has fallen even further on the charts.

My dd has had 2 bone age scans the last one had her bone age 2.5 yrs younger than her "birth age." She fell off the charts at 12, but she was no where near puberty. At 12, her bone age was that of a 9.5 yr old. She is now 14.5 yrs old, she is 4'10" and weighs 92#. She is in puberty, but she has not hit final stages of puberty yet (mensus).

What would concern me about your ds is his mind set (how he wants to stay small). I understand how wrestlers think. I have 2 nephews who are very into wrestling. The staying small really only works when they are younger and will not benefit him when he gets to HS, which is probably right around the corner. The lowest wgt class is 103#. Most of the kids who wrestle 103# are kids who are cutting weight and then they give the 3# grace, so he will easily be wrestling kids who are 106#. My one nephew is a phenominal wrestler, but going into the season (HS season as a freshman in HS) he was only 96#. He was eating everything in sight and trying to put on wgt. He's still trying to, he wants to get 100#. He knows he will wrestle 103# again as a sophomore. Even though he's a really good wrestler, he would sometimes be giving up 10# and it turned out to be too much. If he couldn't pin the kid quickly he would usually end up going to decision and not necessarily win because the wgt difference would kick in. I really think your ds needs to think about his future and how being small is not necessarily a good thing and in his sport it will actually come to hurt him, not help him.

 

[MdGymMom01]

I totally agree with Grannysmith. I also wanted to add that kids are very perceptive and often "hear" what is said all around them. The fact that you have two gymnasts in the house (I know the older one no longer participates) and their small size and tinyness is often commented on and sometimes praised, may be giving your son an "ideal" to live up to. Gymnastics and wrestling are very weight and body-conscious sports and often "being small" is thought as being the ideal to be successful. I would talk to your son and let him know exacty what Grannysmith said about how the weight requirement changes in HS and how it is not to his advantage to be small. Reinforce that it is better to be strong and healthy as opposed to "making a certain weight". Good luck and I hope his eating and body image improves.

 

[Blackie6]

Lilgymmie,

My son is in very similar situation. He will also be 13 in June. Wrestling is very big in our town, yet my son didn't start until late, about 3 years ago. He has been pretty much wrestling the same weight all three years. First two years he was about 82-85lbs getting stuck in matches with about 90lbs opponants sometimes. This year going into Middle school he really had no growth, but his weight did go up to about 90lbs. He hated it, the lightweight group has some phenoms at the 90, 95lb divisions. While he is strong, his lack of experience and those extra pounds on his opponants left him frustrated. His schedule was intense (last yr our town was #1 in the state so all our programs are intense, LOL) with practice 6 days a week! Who says only gymnasts have crazy long practice hours? He dropped a couple pounds right away, but his mind set changed. He was worse than the ladies on America's next top Model! He was never a big eatter, but now he was only taking a sandwich & drink to school. Healthy snack and water at practice. My 10 yr old DD eats more than he does at dinner. He just did not want to wrestle that group of kids at 90lbs! He has a history of stunted growth. As a toddler was about 30 lbs for about 2+ years to the point we were buying him choclate milk shacks to get some fat on him. This is his 3rd yr at this weight range so I have been keeping track of the situation. I am expecting a spurt this Summer, but if not, we will also be checking the Endo route too.

What is your sons history? Has he had periods of seemingly low growth with height and weight history like my son? Do you feel the weight thing due to wrestling is also imbedded into his brain and possible causing his low growth? Do you see him eating and/or does he talk about not wanting to eat because of "making weight". I do know people that have had the bone age done and it has shown about a 2 year less in chron.age. There will still be growth, but it may not be according to the charts like Granny SMith mentions. Another thing that jumps out at me is his ADD meds. Is it possible it is causing him to not even have an appetite in the first place? I think your on the right path to keep an eye on it. Keep us posted! We can wait for our sons growth spurts to happen this Summer together!

 

[coachmolly]

I have quite a bit of experience with anxiety meds, not the same as those used for ADHD but I imagine some of the side effects can be similar. Many of these medications work differently with each person, causing weight gain for one and weight loss or lack of appetite for another. As a child my weight was monitored constantly on these medicines to make sure it was not going in the extreme in either direction, so it is something to be aware of.
Another avenue to pursue (after checking things out with doctors and what not) would be a nutritionist. They might be able to provide some basic nutrition counseling if the wrestling is fueling some of the concerns and offer a reasonable diet plan that would help him to be healthy and have the strength needed to continue wrestling.

 

[bpatient]

I’d like to offer two comments despite my lack of relevant expertise:

First, it seems that anorexia or appetite suppression is quite common among kids treated for ADHD: the literature review that I just checked suggested that this may occur in 80% of treated children.

Second, I understand from personal experience that weight and body image pressures are, as you obviously realize, not confined to females in our culture. Some years ago and only a couple of weeks after a master’s degree candidate passed through our area measuring various physical parameters of rock climbers, I happened to be at the current super-secret overhanging cliff of the day with a few exceptionally talented climbers. (As I recall, the other guys—all of the other climbers that day happened to be male—had all been featured on the covers of climbing magazines, while I had appeared once in a full-page photo only because I happened to have been on an exceptionally beautiful climb.) Although young male athletes typically carry about six to thirteen per cent body fat, at ten per cent (a figure that I figured really wasn’t too bad for a forty-year old male) I was clearly carrying more excess baggage than the younger athletes at the cliff—they proudly traded the results of their recent measurements, which had them, as a group, in the body fat range usually seen in world-class distance runners and cachexic patients in their last hours. During a full day of climbing exceptionally difficult routes, I seem to recall that that group consumed in total about one and a half Power Bars and perhaps three grapes. That seemed really sick, so I responded in the logical way: I dropped several pounds.

Yeah, guys do it, too—but wrestlers face more pressure than most of us. I agree that it might be worth following up on the psychological questions raised in some of the responses to your message. The double whammy of appetite suppression and wrestling-induced fear of weight gain sounds like a powerful combination. FWIW, when I was a skinny kid who played football, my mother plied me with chocolate-banana milkshakes—powerful enough to overcome appetite suppression in almost anyone who is not actively resisting weight gain. (Those were the days.)

 

[lilgymmie7]

Lilgymmie,

What is your sons history? Has he had periods of seemingly low growth with height and weight history like my son? Do you feel the weight thing due to wrestling is also imbedded into his brain and possible causing his low growth? Do you see him eating and/or does he talk about not wanting to eat because of "making weight". I do know people that have had the bone age done and it has shown about a 2 year less in chron.age. There will still be growth, but it may not be according to the charts like Granny Smith mentions. Another thing that jumps out at me is his ADD meds. Is it possible it is causing him to not even have an appetite in the first place? I think your on the right path to keep an eye on it. Keep us posted! We can wait for our sons growth spurts to happen this Summer together!

My DS has been typically very small for his age since he was born. As he was growing up, he faced a lot of pressure from friends and classmates because of his size. Many times he came home crying because of it. This past year he has made a lot of attempts to come to grips with the peer pressure and he has reversed his mind set and has begun to say, "I like being small. Smaller wrestlers do better." These comments are in my opinion really 'masking' how he really feels.
Thank you all for your concerning comments and expertise. Since DS was 7 he has been under the care of a psychiatrist and counselor at the Children's hospitol in our city. His meds are regulated by his psychiatrist, and he visits his counselor at the hospitol weekly. His fixation on weight is one of the focal points in his counseling. His doctors and I are not certain what is triggering his fall from the growth chart. We are scheduling a visit to an endocronologist but are just waiting for the referral from his PCP.

I have become very concerned with his reversal of mindset about his weight. Last year, he hated to be the smallest in his class. But this year, he welcomes it. He talks about it a lot however and all of our ears are up due to it. Anorexia scares me, therefore I am not stopping until we figure this out. Over the summer, I took him to see a nutritionist. She told us that he is lactose intolerant and he has been drinking soy milk ever since. She told him that he needed more protein in his diet as well, but he has never really been a big meat eater. We then began giving him protein shakes.

Thank you all once again. If anyone has further information, I certainly welcome it all. I am taking note, and it is really helping me to continue on and realize I am not off base.